HoLEP may provide more durable benefit than PVP in patients with BPH

Both holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP) are safe and effective day-surgery procedures for treating benign prostatic hyperplasia (BPH) in men with small to medium-sized prostates.

Considering the reoperation rate during 24 months of follow-up, however, HoLEP appears to have better long-term stability.

“BPH is common in aging males and the most common cause of lower urinary tract symptoms. Both HoLEP and PVP have been described as day-surgery treatment for BPH. Our study compared the two procedures in a prospective, randomized trial with 24 months of follow-up,” said Yan Bo Chen, MD, department of urology, Shanghai Ninth People’s Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China.

Chen presented the study findings in a live poster session during the 2020 European Association of Urology Virtual Congress. It enrolled 314 patients who were randomized 1:1 to the 2 surgical procedures.

To be eligible for inclusion, patients had to be <80 years of age and have a prostate volume <60 mL as estimated by B-ultrasound, International Prostate Symptom Score (IPSS) >15, good bladder detrusor function and significant lower urinary tract obstruction based on urodynamic examination, and good cardiopulmonary function. Patients with severe pulmonary disease or cardiac disease, bladder calculus, neurogenic bladder dysfunction, bladder cancer, previous prostate surgery, prostate cancer, urethral stricture, or coagulopathy were excluded from study participation.

There were no significant differences between the HoLEP and PVP groups at baseline in mean IPSS (23.6 vs 23.5), quality of life (QoL) score (4.5 vs 4.6), maximum flow rate (Qmax; 7.32 vs 7.1 mL/s), or prostate volume (44.7 vs 45.9 mL). Mean operation time was significantly shorter for HoLEP compared with PVP (52.3 vs 46.6 min; P<.001), Chen reported.

“All of the surgeries were performed by urologists who were skilled in both procedures,” he said.

The postoperative results showed a high rate of successful catheter removal within 24 hours after both HoLEP and PVP (94.9% and 96.2%, respectively) with no statistically significant difference between groups. Data for the efficacy end points showed no statistically significant differences between the 2 groups in mean IPSS, QoL, or Qmax values after 1, 6, 12, or 24 months of follow-up. At the last visit in the HoLEP and PVP groups, mean IPSS was 5.3 and 5.8, respectively; mean QoL score was 1.2 and 1.3, respectively; and mean Qmax was 22.8 and 20.6 mL/s, respectively.

Prostate volume was measured at 6 and 24 months and was significantly lower in the HoLEP group than in the PVP-treated patients at both the earlier (29.8 vs 33.4 mL; P <.001) and later assessments (30.3 vs 39.2 mL; P <.001).

Postoperative complications in the HoLEP and PVP groups included urethral stricture (3.8% and 5.1%, respectively), bladder neck contracture (1.3% and 3.8%, respectively), and transient incontinence (13% and 2.5%, respectively). The between-group difference was statistically significant only for the rate of transient incontinence (P =.025).

Whereas six patients underwent a reoperation in the PVP group (3.8%), there were no reoperations in the HoLEP group.

Reference

1. Chen YB, Chen Q, Gu M, et al. A prospective, randomizised clinical trial comparing holmium laser enucleation versus photoselective vaporization for day-surgery to treat benign prostatic hyperplasia. 2020 European Association of Urology Virtual Congress. July 17-26, 2020.

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